Effect of permanent pacemaker on mortality after transcatheter aortic valve replacement

Abstract

Objectives. Transcatheter aortic valve implantation (TAVI) is an established treatment for high-grade aortic valve stenosis in patients found unfit for open heart surgery. The method may cause cardiac conduction disorders requiring permanent pacemaker (PPM) implantation, and the long-term effect of PPM implantation remains ambiguous. Design One hundred sixty-eight patients who underwent TAVI from 2008 to 2012 were included. Patient characteristics, ECGs and PPM data were collected through medical records. Kaplan–Meier plots and Cox regression analysis were performed. Results. Forty subjects were excluded, leaving 128 patients for final inclusion. 41 (32%) received a PPM (mean age 82 vs. 80 in patients without PPM, p = .06) within 30 days of the TAVI procedure. Median follow-up was ∼4 years and 37 (29%) died. One-year mortality was 14% for non-PPM patients vs. 2% in PPM patients, and mortality at 5yrs 70% vs. 54%, respectively. Kaplan–Meier survival analysis showed higher mortality in patients without PPM (p = .008). In multivariate survival analysis significant variables were: No PPM (HR 2.6; CI 1.1–6.2; p = .03), chronic obstructive pulmonary disease (HR 2.4; CI 1.2–5.0; p = .02) and either pre- or post-procedural chronic or paroxystic atrial fibrillation (HR 2.3; CI 1.2–4.7; p= .02). Conclusion. TAVI-patients with a PPM had better survival than patients in whom a PPM was not implanted.

Keywords:

• TAVI
• pacemaker
• mortality

Acknowledgments

We thank Fredrik Olson for assistance with data gathering, and Maria T. Lauritsen for help with analyzing ECGs.

Disclosure statement

No support in the form of grants, equipment or drugs have been supplied by third parties. The study complies with the Declaration of Helsinki. All authors have no conflicts of interest to declare.